Generally, three types of bariatric procedures are typically performed on patients for the treatment of morbid obesity. The various surgical procedures include vertical banded gastroplasty (“VBG”), laparoscopic gastric banding (“Lap-Band”), and the Roux-en-Y gastric bypass (“RYGB”).
The RYGB procedure is a complex surgical procedure in which a small upper pouch P is created by stapling the stomach S and separating the pouch P from the remaining stomach S, which is left in place in the patient body. A Y-shaped segment of the intestines I (Roux limb), such as the upper jejunum JE or ilium IL, is rerouted and attached to the newly created pouch P via an anastomosis PA, as shown in FIG. 1A. The remaining portion of the jejunum JE is then reattached to the Roux limb at a lower point via an anastomosis IA. This rerouting causes food to pass through the esophagus E, through the pouch anastomosis PA, and into the Roux limb to bypass the stomach S. The pouch P further restricts the food intake and interferes with absorption to result in consistent weight loss.
In creating a VBG, a surgical stapler is used to form a staple line SL to create a small gastric pouch out of the stomach S just below the esophagus E. A non-adjustable polypropylene mesh band B is placed around the bottom of the pouch and through a circular window W created through the stomach S to restrict the size of its outlet, as shown in FIG. 1B. The small pouch and narrow outlet restricts the amount of food the patient can comfortably consume and delays the emptying of food into the remaining portion of the stomach S and duodenum DU.
However, in these types of surgical procedures, there is typically a failure rate of about 20% which is categorized into two types: acute and chronic failures. Acute failures are generally due to patient intolerance, leaks from either the pouch P or anastomoses PA and/or IA, and other complications. Chronic failures generally occur in about 10-20% of patients who fail to lose any significant amount of weight. The typical two failure modes occur from either (1) dilation of the pouch P, for example, where the pouch P expands from a 20-30 cc pouch to a 100-300 cc pouch; or from (2) dilation of the stoma through the pouch anastomosis PA, for example, where the stoma dilates from a 10-12 mm diameter to a 3-5 cm diameter.
Options for correcting these failures are limited to either simply leaving the dilated tissue or to perform an open surgical revision procedure to alter the length of the Roux limb to decrease absorption. However, such a procedure is typically accompanied by a 2-5% mortality rate and a 50% failure rate and is extremely difficult to perform due to the altered tissue anatomy. Moreover, minimally invasive laparoscopic surgical revision procedures are also extremely difficult because of the altered tissue anatomy and scar tissue.
Accordingly, in view of the foregoing, it would be desirable to provide minimally invasive methods and apparatus for performing endoluminal revision procedures to correct failed surgical procedures for obesity.